Case Summary

A deep Gastric ulcer with formation of fistula buried in the posterior stomach wall, at the lower half of the body of the stomach along the leaser curvature in a 65 years old male patient was evaluated while undergoing “Esophagogastroduodenoscopy” for clinical features resembled to simple mild gastritis not responding to Proton Pump Inhibitor therapy. The channel was about 3 cm long, buried in to the posterior wall of the stomach close to the leaser curvature with superior wide and sliding opening of about 1.8 cm and a lower comparatively constricted opening of 0.8 cm, approximately 4.5 cm above the pyloric sphinter. The patient was overweight, hypertensive, non-diabetic, non-smoker with irregular alcohol consumption and no regular history of NSAID. His C13 Urea breath test was found negative and histopathological examination of biopsy specimens confirmed diagnosis of Carcinoma (Figures A-E)..

Figure A, B & C: Endoscopic image of the Upper end and opening of the fistula (pseudo channel) in the posterior stomach wall with deep wide ulceration along leaser curvature.

Figure D & E: Endoscopic view of the lower end and opening of the Fistula about 4.5cm above the pyloric sphinter.

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